Film: Posted Calorie Counts Understate Truth

(AP Photo/Charles Krupa)

(AP Photo/Charles Krupa)

“Aha! I suspected as much!”

That was my reaction upon viewing this charming and eye-opening new short film about testing the posted calories counts in New York City.

More and more chain restaurants are posting the calorie counts of the foods they serve, whether because of local rules, as in New York or, soon, nationwide under Obamacare. But, film-maker Casey Neistat points out in “Calorie Detective,” no one actually checks the accuracy of the posted calories, at least in New York. And, I would add, those of us with suspicious minds often find the purported calorie counts to be oddly…..low.

Casey decides to seek the help of some obesity researchers with a “calorimeter” among other impressive equipment, and do some checking himself. Watch the film for the full effect, but suffice it to say that he calculated that in a typical day, he’s getting more than 500 extra calories beyond the posted counts — about as many as inadvertently eating a quarter-pounder with cheese or two Snickers bars. (And what fun is accidental eating?)

The worst offender — wouldn’t you know it? — is the super-healthy-looking spicy tofu sandwich, which claimed to be 228 calories and actually measured out to 548. And the most virtuous food-maker: Subway, whose 6-inch turkey sub was actually a few calories less than the advertised 360. (So does this make up for that recent 11-inch foot-long scandal?)

Readers, do you have any particular suspicions about any Boston-based calorie counts? If we have some likely culprits, perhaps we could enlist some public-minded scientists here to do the lab work…

Health Affairs: Many Don’t Know They Can Get Preventive Care Free

Here’s my suggestion for holiday lights over the White House: Big neon letters that read: “You can now get lots of preventive care with no out-of-pocket costs!”

Under the federal health reform known as Obamacare, preventive care like check-ups and vaccines must now be largely free, and insurance companies may not charge co-pays for much of it. (Actually, it’s more nuanced than that, as my far more knowledgeable readers Amy Lischko and Dennis Byron explain below, and I altered my neon message above in response.)

In any case, a great many people do not know which preventive care is now free to them; a poll last year found that more than 40% of Americans did not know that Obamacare bans “cost-sharing” for preventive care. And the trouble is, if you don’t know preventive care will cost you nothing out of pocket, you may not get it, and thus fail to reap the benefits of staving off illness before it hits.

A new study just out in the journal Health Affairs finds a similar “people-don’t-know-what’s-free” problem with high-deductible health insurance called “consumer-directed” plans. The title says it all: “In Consumer-Directed Health Plans, A Majority Of Patients Were Unaware Of Free Or Low-Cost Preventive Care.” From the press release:

Patients in high deductible consumer-directed health plans avoid preventive care due to unnecessary fears over cost. Consumer-directed plans typically exempt recommended preventive visits and tests from the plan’s deductible, or require only a small copay. These plans have grown in popularity, increasing to 19 percent of all covered workers in 2012 from 8 percent just three years prior. Mary E. Reed, of the Kaiser Permanente Northern California Division of Research, and coauthors found that more than half of the 456 Northern California-based respondents surveyed did not understand their plan benefits for preventive office visits and approximately one in five delayed or avoided a preventive visit, test, or screening because of cost. Continue reading

When The Full Sticker Shock Of Health Coverage Hits Our Family

medical bill

(Attercop311/ Flickr Creative Commons)

As the new state Health Policy Commission begins its work to bring down health care costs, here’s one Massachusetts family’s reminder of why the issue is so urgent. The excruciatingly high prices of both insurance and care mean that some must choose between health insurance and a new furnace, or health insurance and a car. This is not an abstract policy issue; it is a daily burden with major effects. One mother’s story:

By Sara Cushing
Guest contributor

A few weeks ago I resigned from my job as a project manager at one of the largest health care delivery systems in the United States. I have worked in different capacities in the health care industry in the Boston area for the last eleven years, but decided to leave my career because I wanted a change — to follow my dream of becoming a writer.

Many things needed to be considered about such a family-life-altering decision, including one that hadn’t been a concern of mine in the past: what my family’s next steps would be in purchasing health insurance. I have always carried the health insurance — a very robust PPO (“paid provider option”) family plan that was largely subsidized by my employer.

Sara Cushing

Writer Sara Cushing

The direct cost to me (paid bi-weekly on a pre-tax basis) was roughly $400 a month. In discussing my career departure with my husband, we knew that the monthly cost for a similar plan purchased through the Health Connector (the Massachusetts state agency that acts as a vehicle to allow uninsured residents to purchase health insurance through local health insurance companies) would likely be higher. Much higher.

Try something closer to $1700. About the same as our monthly mortgage. About half of what my take-home pay used to be — money that was no longer coming in. And we see no way around it.

Because my husband is in a higher income bracket we’re not eligible for subsidized coverage though the state; and because my husband is a contract employee, his employer doesn’t provide subsidized health care coverage.

This means that we’re looking at the same cost for a family plan whether we buy through his employer; the Health Connector; or through my employer’s COBRA plan (which allows me to purchase the same health care coverage as offered by my employer for up to 18 months after ending employment, though I am responsible for 102% of the cost — the additional 2% is for administrative fees).

I live in Massachusetts, where legislation was passed a few years ago mandating health care coverage for all residents. The legislation helped to create the Health Connector agency so that people could purchase health insurance in larger risk-pools instead of directly from health insurance companies, to allow for more competitive pricing and coverage options for individuals and families.

This all sounds great, right? What many people do not understand, however, is just how steep the monthly premium cost gets, just how painful a $1700 bite out of a family budget can be. Continue reading

Grill & Wings Owner Tacks On Obamacare Surcharge, HuffPo Reports


File this one under: really, really insensitive boss.

The Huffington Post reports that the owner of a Denny’s franchise in West Palm Beach is adding a new “Obamacare surcharge” to his customers’ bills. The owner, John Metz, suggests that customers consider reducing their tips to servers to compensate. HuffPo writes:

John Metz said he will add a 5 percent surcharge to customers’ bills to offset what he said are the increased costs of Obamacare, along with reducing his employees’ hours.

“If I leave the prices the same, but say on the menu that there is a 5 percent surcharge for Obamacare, customers have two choices. They can either pay it and tip 15 or 20 percent, or if they really feel so inclined, they can reduce the amount of tip they give to the server, who is the primary beneficiary of Obamacare,” Metz told The Huffington Post. “Although it may sound terrible that I’m doing this, it’s the only alternative. I’ve got to pass the cost on to the consumer.” [My bold.]

Metz is the franchisor of Hurricane Grill & Wings, which has 48 locations, five of which are corporate owned, and president and owner of RREMC Restaurants, which runs approximately 40 Denny’s and several Dairy Queen locations. He planned to use the 5 percent surcharge tactic in all his restaurants starting in January 2014, when Obamacare is fully implemented.

Chef Chang: Absorb Obamacare Costs And Do Right By Workers

Chef Joanne Chang


WBUR’s Cognoscenti posts a column today by restaurateur and celebrity chef Joanne Chang that will surely be of wide interest to her food-industry colleagues around the country — and other small business owners as well. She says, in effect, that yes, the federal health reform known as Obamacare will add to your business costs by requiring health insurance for employees, but it is wrong to reduce good employees’ hours in order to avoid getting them covered.

She begins with a question she heard at a recent meeting of restaurant professionals:


“If Obamacare stays in place, will you reduce your staff’s hours so that they are no longer full-time and thus you won’t have to cover them under your health plan?” And her response:

As the only business owner from Massachusetts, where a health care law that closely resembles the president’s Affordable Care Act has been in place for the last five years, I shared my experience (and tried to hide my shock). No, we did not reduce hours — nor did we even consider it. If someone strong is working for you, it seems counterintuitive to have them work less, even if it costs you a bit more.

My business has absorbed the costs associated with the new health mandate in the same way we absorb rising fuel surcharges or higher prices of flour. They cut into our profit, sure, but when I weigh the cost of paying staff to cover for chronically sick employees who don’t see a doctor because they don’t have one, or the pressure of knowing that my 24-year-old barista can’t afford coverage because he only makes $10 an hour, I willingly take the cut to my bottom line.

Read the full post here.

Medicare Savings? Cadillac Plans? Fact-Checking Mass. Senate Race Claims

warren brown debate

Democratic challenger Elizabeth Warren speaks during a debate with Republican incumbent Sen. Scott Brown in Springfield. (Elise Amendola/AP)

The sweeping federal health care law is a key point of disagreement between Sen. Scott Brown and his challenger, Elizabeth Warren.

Brown, a Republican, vows to repeal the law and let states craft their own health care reform plans. Warren, a Democrat, supports the federal Affordable Care Act and says the country must stay with the gains already made under the law.

In the last two weeks of this campaign, you’ll likely hear many competing claims about how the law will affect you; here are two.

The first claim is about Medicare, the government program of health coverage for most Americans 65 or older. The political action wing of Boston-based Community Catalyst is out with a report that says repealing the Affordable Care Act (ACA for short) would hurt seniors.

Community Catalyst Action Fund Director Rob Restuccia says seniors would see their Medicare costs increase about $500 a year if the law is repealed. Medicare members who take a lot of medications and hit the “donut hole” could see their costs increase up to $1,700 a year, according to projections from the Obama administration.

“We know that the drug costs are lower (under the ACA),” Restuccia says. “We know that there’s preventive services that seniors are getting, but also their premiums are lower. Put it all together and it’s a big deal for seniors.”

And here’s the reason that Restuccia is sending out this analysis.

“We think that Sen. Brown and others are really distorting what the Affordable Care Act does.”

Restuccia’s right: Brown doesn’t talk about Medicare saving seniors money. He talks about Medicare cuts. Brown calls the $716 billion that the Congressional Budget Office says Medicare plans to save through lower reimbursements to doctors, hospitals and health insurers “cuts to Medicare.”

There’s the competing claim about what happens to Medicare under the ACA: savings versus cuts.

The second claim you’ll hear has to do with everyone who has private insurance, usually through their employers. The federal law includes a tax on Americans with what are known as “Cadillac” or top-of-the-line health insurance plans. Continue reading

New Yorker: ‘Beware Of Romneycare’ Sums Up Candidate Contrast On Health Care

Former Massachusetts Gov. Mitt Romney (AP)

When the New Yorker headlines this week’s financial column “Beware of Romneycare,” it’s not referring to the Massachusetts version, the near-universal health coverage that then-Gov. Mitt Romney helped usher in. It’s referring to the current Romney, who has made clear that if elected president, he will work to repeal the federal version of health reform, Obamacare.

Now, The New Yorker just endorsed Obama for president, so that may color your view of its columns. But the ever-excellent economics writer James Surowiecki does lay out with beautiful clarity the stakes of the coming election: “Health care is where the election’s outcome will have the most immediate and powerful impact on how Americans live,” he writes. And he zeroes in on the essence of the difference between the candidates:

‘It’s like saving on defense by protecting only two-thirds of the country’

“The premise of Obamacare is that healthcare is a collective good, like national defense, something that government has to help provide,” he writes.

In contrast, he writes, what Romney wants…

…”is just to have the government less involved in health care. Insofar as his plans would lower federal health-care spending, it’s not because of the power of the free market; it’s because a Romney administration would simply have the government do less. Romney would eliminate the Obamacare subsidies for health insurance. He would turn Medicaid into a block grant to the states and trim its annual budget, with the result that its funding woudl lag behind the rise in health-care costs. And if he adopts his running mate Paul Ryan’s premium-support plan for Medicare, he would make Medicare recipients pay higher premiums. With these changes, the government would spend less, but only because it would provide less, and Americans would get less. It’s like saving on defense by protecting only two-thirds of the country”

Ultimately, he writes:

“The real issue, come November, isn’t about who has the best ideas for controlling health-care costs. It’s about who has the right idea about what government should do.”

The full piece is very worth a read; it also includes a succinct history of the thinking on why the free market doesn’t work well in health care.

Politico: Mass. Democrats Stump For ‘Romneycare’ In Nevada


A shadow is cast as a stand-in for President Barack Obama speaks at the podium during a rehearsal for a debate at the University of Denver. (AP)

Politico’s “Pulse” bulletin reports:

MASS. DEMS DISPATCHED TO TALK UP ‘ROMNEYCARE’ – You know how we said yesterday that no one’s really talking about the flaws in Mitt Romney’s 2006 health care law? We offer our latest exhibit: Two Massachusetts Democrats, at the urging of the Obama campaign, are dropping into Nevada this week to talk up the law that eventually gave rise to the ACA. Massachusetts House Majority Leader Ron Mariano and State Rep. Steven Walsh will visit the Silver State tomorrow and Thursday to contrast Romney’s work on the state law with his promise to repeal “Obamacare” and boost insurers’ involvement in Medicare. The POLITICO Pro story: http://politico.pro/QjVrez

Politico Pro requires a subscription, but Politico’s “Pulse” bulletin offers a bit more free fun: Its staffers write that “we’ve been pondering a health care-themed drinking game for [tonight’s] presidential debate. But we also want to make sure there’s a Thursday morning PULSE, so … we’ll take a rain check.”

Hmmm. A health care-themed debate game for tonight?? NBC news has a fascinating analysis here that finds that health care is the biggest issue of the campaign. Should we maybe all do ten sit-ups whenever “care” is used as a suffix to a candidate’s name? Nah, too virtuous. Does anyone have a better suggestion?

Homer Simpson On ObamaCare

Thanks to Sarah Kliff at Wonkblog for posting this great clip on Homer Simpson’s assessment of ObamaCare. (She also posted an excellent, vegetable-packed piece on how the ACA truly kicks in for hospitals today with new penalties for excessive readmissions and higher Medicare payments redistributed to hospitals delivering better care).

For now, here’s the lighter of the two posts:

Snapshot Of Obama, Romney Care From Guys Who Were There

(Updated at 3:50 pm with additional material.)

Let’s just get this out in the open: Jon Gruber has an agenda.

He really likes President Obama’s Patient Protection and Affordable Care Act. Heck, Gruber, the MIT economist, even wrote an entire comic book about the law (and served as an advisor to the president in developing the national plan). So, when he joins forces with Stuart Altman, professor of national health policy at Brandeis and John McDonough, director of the Harvard School of Public Health’s Center for Public Health Leadership to compare the “impacts of ObamaCare, RomneyCare, and RomneyCandidateCare on health care consumers in every state,” you’ve kind of got an idea of where they’re coming from.

Still, the comparison is useful in reinforcing their message with some numbers.

What the analysts found in comparing the president’s approach to candidate Romney’s “composite” set of health care proposals — which includes repealing the ACA — is this: ObamaCare is better all around because it helps more people gain access to health insurance and pay for their care.

As Gruber put it in a conference call with reporters today, ObamaCare and RomneyCandidateCare offer two “completely different” visions. “Rather than fixing the problem, RomneyCandidateCare will make things worse,” he said.

The full report is here. (Even the cover underscores the authors’ perspective with a photo of Obama next to two pictures of Romney, each facing a different direction. To me it screams “flip-flopper.” Am I alone here?)

(Families USA)

Still, there is serious content inside. Continue reading